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Biomedical subjects

S M Shapshay

Publications and source records attributed to S M Shapshay.

At least 91 records · Page 5Linked to original sources
PubMed1986

Management of facial angiofibromas in tuberous sclerosis: use of the carbon dioxide laser.

Facial angiofibromas are estimated to occur in 90% of patients with tuberous sclerosis and can cause considerable cosmetic disfigurement, emotional distress, obstruction of vision, and hemorrhage when abraded. Postoperative wound management associated with skin grafting and dermabrasion is often difficult because patients are mentally retarded and noncooperative. Three patients with extensive facial angiofibromas were treated successfully with the carbon dioxide (CO2) laser, with follow-up period ranging from 8 to 48 months. Uncomplicated wound healing occurred in each patient with minimal recurrence of lesions. Ablation with the CO2 laser is our treatment of choice for angiofibromas associated with tuberous sclerosis.

Adult↗
PubMed1986

Safety precautions for bronchoscopic Nd-YAG laser surgery.

The application of the neodymium-yttrium aluminum garnet (Nd-YAG) laser in bronchoscopy originated in Europe in 1981 and is now widespread in the United States. Transmissible through flexible fiberoptic quartz fibers and an efficient coagulator of tissue, the Nd-YAG laser deeply penetrates tissue not readily predictable by the endoscopist. Dangers associated with the Nd-YAG laser include complications secondary to inadvertent exposure to normal tissues or structures, tracheobronchial accidents (perforation, hemorrhage, fire), and complications related to anesthetic technique (respiratory depression). Hypoxemia related to persistent hemorrhage, accumulation of secretions or debris or both, or anesthesia-induced respiratory depression is the common denominator of most intraoperative and postoperative complications. Careful selection of patients, intraoperative monitoring of ventilation and blood gases, and techniques of rigid bronchoscopy are stressed to avoid complications.

Anesthesia↗
PubMed1986

A simple handheld device for the Nd:YAG laser.

A disposable Frazier suction instrument which is used as a handheld device in order to guide the Nd:YAG laser fiber in the treatment of different diseases is described herein (Fig 1). This device provides the operator with better stability to approach the target in the application of the Nd:YAG laser.

Humans↗
PubMed1985

Endoscopic treatment of tracheobronchial malignancy. Experience with Nd-YAG and CO2 lasers in 506 operations.

Laser technology and the endoscope have been combined for the palliation of obstructive tracheobronchial malignant lesions. The neodymium-yttrium-aluminum-garnet (Nd-YAG) laser was used to treat 249 patients (447 operations), and the CO2 laser was used on 34 patients (59 operations). Hemorrhage, the major complication in both groups of patients, was more easily controlled with the Nd-YAG laser. One patient in the CO2 laser group died, and one patient in the group being treated with Nd-YAG laser bronchoscopy died. The Nd-YAG laser can be applied more efficiently through a fiber system, with better optic control and secure hemostasis. The commonest indications for treatment were dyspnea, obstructive pneumonia, and hemoptysis. Extrinsic compression was the most frequent reason for failure. The Nd-YAG laser, most often applied through open rigid bronchoscopes under general anesthesia, has become our treatment of choice for the palliation of tracheobronchial malignancy.

Adenocarcinoma↗
PubMed1985

More about the YAG.

Explore the source record for details and available documents.

Bronchial Diseases↗
PubMed1985

Treatment of cancer of the larynx. Analysis of success and failure.

The treatment of patients with cancer of the larynx must consider the potential for multiple sites of origin and the possibility of regional metastasis. Treatment options must also address effects on the voice, deglutition, and the sphincteric function of the larynx which protects the lungs. Fortunately, our advanced techniques in surgery--reconstruction, radiotherapy, and endoscopic laser application--enable us to choose from and use these modalities in combination. Induction chemotherapy appears to be a promising, albeit unproved, adjuvant therapy. The oncologist dealing with cancer of the head and neck must select appropriate individualized therapy in a multidisciplinary environment.

Carcinoma in Situ↗
PubMed1984

Nd-YAG laser therapy for tracheobronchial disorders.

The neodymium-yttrium aluminum garnet (Nd-YAG) laser has demonstrated its effectiveness in treatment of a number of benign and malignant tracheobronchial disorders. This laser has many advantages over past methods of endobronchial therapy, such as cryosurgery and electrocautery. It is a precise, no-touch method that produces little pain during therapy and little or no edema or infection afterward. Since the laser is a form of nonionizing radiation, therapy may be repeated as often as needed. Unlike the carbon dioxide laser, the Nd-YAG laser may be used with standard flexible endoscopes. Currently, the commonest indication for Nd-YAG laser therapy is obstruction of a large airway by an inoperable neoplasm. Whether this technique can be applied more widely in management of early lung cancer, possibly in combination with radiotherapy, chemotherapy, or surgery, will be determined by further study.

Airway Obstruction↗
PubMed1984

Argon laser and soft tissue interaction.

The interaction of the argon laser with the mucous membrane of the upper aerodigestive tract was studied. The advantages of the argon laser are a small spot that can be varied in size and intensity, selective vascular absorption, the capability of being incorporated into a flexible delivery system, and a coincident aiming beam. The acute soft tissue effects are characterized by subepithelial extension, with a variable delayed reaction between the application of the laser and a detectable break in the epithelium. Postoperative edema persisted, with an increase in the lateral spread of the lesion over 3 days and an acute inflammatory reaction extending over 7 days. By 21 days the lesions were reepithelialized and healed, but their width was 30% greater than the original defect. The unpredictable interaction with soft tissue, the postoperative edema, and the quality of wound healing are disadvantages. The argon laser appears to have limited clinical potential as a surgical tool for the air and food passages.

Animals↗
PubMed1984

Excisional biopsy in the selective management of T1 glottic cancer: a three-year follow-up study.

Transoral excisional biopsy has been used in the evaluation and management of 103 T1 glottic cancers. A 3-year follow-up on these patients indicates that excisional biopsy unequivocally established the diagnosis and stage of the disease and that it is adequate treatment for micro and mini squamous cell cancers of the glottis in which the margins of excision are clear. Excisional biopsy with positive margins and larger T1 tumors establishes the absolute need for radiotherapy. Excisional biopsy is ideal for the diagnosis and management of verrucous carcinoma and spindle cell carcinoma. Recurrent/residual squamous cell carcinoma after radiotherapy should be explored by excisional biopsy which may be curative or will establish the need for partial or total laryngectomy. The appropriate use of excisional biopsy in the selective management of early T1 glottic cancers requires attention to detail by the surgeon and the pathologist and sound clinical judgment.

Biopsy↗
PubMed1984

Treatment of hereditary hemorrhagic telangiectasia by Nd-YAG laser photocoagulation.

Hereditary hemorrhagic telangiectasia (Rendu-Osler-Weber disease) is an inherited abnormality of the vasculature characterized by abnormal subepidermal vessels. Frequent, sometimes severe, epistaxis often requiring blood transfusions is present in most patients. Septal dermatoplasty and estrogen have proved to be the most successful therapies. However, the frequency of failure in treatment has stimulated a search for an alternative therapy. The Nd-YAG laser was used at low-power settings (20-25 W) to treat 6 patients with hereditary hemorrhagic telangiectasia, all of whom had been treated previously using other modalities. Laser photocoagulation diminished the frequency and severity of hemorrhage in 5 of 6 patients without complications (6 to 9 month follow-up period). The Nd-YAG laser may be used repeatedly when new accessible lesions arise, and it appears to be a useful therapeutic option for this disease that is difficult to treat.

Adult↗
PubMed1983

Transoral partial supraglottic resection using the CO2 laser.

Transoral epiglottis resection or partial supraglottic resection was done with the CO2 laser in 20 highly selected patients. Visualization was best accomplished using the Lynch suspension system, but was satisfactory with the Jako-Pilling laryngoscope. The best indications for this procedure were: 1. for visualization of the true vocal cords in previously treated cancer patients whose epiglottis obstructed indirect mirror examination, 2. for removal of obstructing benign epiglottic lesions, 3. as an excisional biopsy in limited epiglottic cancer, especially of the suprahyoid epiglottis. No major complications or operative morbidity occurred. This approach obviated the potential morbidity of external surgical procedures In a select group of patients. Shortened hospitalization, avoidance of tracheotomy, minimal postoperative discomfort and edema, and excellent wound healing were additional advantages seen.

Adult↗
PubMed1983

Palliation of airway obstruction from tracheobronchial malignancy: use of the CO2 laser bronchoscope.

A CO2 laser rigid bronchoscope system has been used to palliate symptoms of a malignancy obstructing the tracheobronchial airway. Fifty-nine endoscopic laser operations (34 patients) were done between 1975 and 1981. Severe dyspnea and obstructive atelectasis were the most common indications for treatment. Contraindications for treatment included extrinsic tracheobronchial compression, widespread distant metastases, rapidly progressing tumors, and highly vascular neoplasms. There were nine primary tracheal malignancies, five metastases from distant sites, and 20 primary lung cancers with tracheobronchial obstructions. Most patients were previously treated with one or more standard modalities (radiation therapy, surgery, and chemotherapy). Removal of airway obstruction was occasionally indicated prior to radiation therapy to facilitate treatment. There were seven instances of complications in this group of patients and one mortality. Most patients (23 of 34) have died from their malignancy. The best palliation was achieved in proximal (tracheal and main stem bronchial), slower growing tumors.

Aged↗
PubMed1983

Lasers in bronchology.

Endoscopic application of carbon dioxide and YAG laser technology is an important surgical adjuvant for the treatment of tracheobronchial airway obstruction. In cases of malignant disease of the tracheobronchial tree, laser surgery should be considered when definitive treatment (surgery, radiotherapy, and chemotherapy) has failed or is not applicable. The importance of careful selection of patients cannot be overemphasized. In selected cases of benign tracheobronchial lesions and stenosis, endoscopic laser surgery may be used with minimal morbidity. Rapid advances and refinements in laser technology and instrumentation present "new frontiers" for the bronchologist. Endoscopic laser surgery has established its place along with standard therapeutic modalities.

Bronchial Diseases↗
PubMed1983

Laser bronchoscopic surgery.

Endoscopic laser bronchoscopy can be used to effectively palliate patients with compromised airways. The CO2 laser was utilized with a ventilating bronchoscope. This form of endoscopic surgery has the advantage of less postoperative edema, better hemostasis, more accurate tumor vaporization, and shortened operating time. Between 1975-79 33 laser bronchoscopies were carried out for airway obstruction. Palliation was achieved in most cases. Complications included intra-operative bleeding, tissue fragment occlusion of the airway, and an endotracheal fire. Laser bronchoscopy should be avoided in the presence of widespread metastatic disease, poorly differentiated or rapidly growing tumors, extrinsic tumor compression, or highly vascular tumors. A preliminary report is presented on the soft tissue effects of the argon laser, passed through a flexible coaxial cable in the canine trachea. Multiple transmural lesions were created. The use of the argon laser in the field of bronchoscopy remains controversial.

Adult↗